Why do people who suffer from anxiety complain a lot about palpitations and skip heartbeats?
Sanjay Gupta: So this is interesting, palpitations basically, I'll just explain what palpitations are because a lot of people ask me about that. Palpitations are a symptom, so all palpitations mean is that you become aware that your heart is doing something it shouldn't. That could be that your heart is pounding, it could be your heart is racing, it could be that your heart is skipping beats, it could be that your heart is beating irregularly, all those would be palpitation. And once you have a patient with palpitation you then have to work out which of those things it is, which will then give you a heart ...
Now, why do they go? For lots of reasons. People who have anxiety tend to be a lot more sensitized to their heart, so they're in a hyper aroused state. And fear will always release more adrenaline and stress hormones and that will automatically cause the heart to beat faster. So if you, for example, a scenario is, we're sitting here and the phone rings.
We wouldn't think anything of it. Imagine, however, if you're alone in the middle of the night and you've been told that there's a murderer going around who rings people on their phones before coming and attacking them.
Barry McDonagh: That'll do it.
Sanjay Gupta: But the ring is the same, nothing has changed between the actual tone of the phone, but the reaction it causes in you is completely different. And so this is because the adrenaline has got ... A, we're hyper aroused anyway, B, you have the stimulus where you get this adrenaline surge, which will then cause our heart to beat and three is that when we are scared, we tend to hyperventilate.
When we're hyperventilating what that can do is that can ... we have important mineral lines called calcium and magnesium in our body and when we hyperventilate we push calcium and magnesium into our blood cells and we get deficient in calcium and magnesium outside in the blood.
And this is why a lot of people complain of tingling, because they become deficient in calcium, transiently. When you become deficient in magnesium, you start getting more extra beats developing. And there's a very interesting study that I'd like to share with you, this was done I think in 1978 by Professor Lown.
And what he did was he took a bunch of people who had anxiety and he strapped them to a monitor. 19 people. And then he did three experiments on them.
The first was that he asked them some arithmetic questions and every time they got it wrong, he would tell them off, making them more anxious. The second thing he did was he took boards where he had the name of a color written in a different color. So he had blue written in a red color and he asked them what the color was and every time people ... because people had to think, it wasn't natural, they got more anxious about that. And then finally he started asking them about, he started doing these interviews with them about their relationships, their childhood, all that kind of thing, getting these people more and more anxious.
And interestingly, as people got more anxious, on the monitor you saw more skipped beats. So I think there is no doubt that you will get more of a heart rate response and you are more aroused, but there is also a physical thing that happens when you get more anxious. You do see extra beats or skipped beats on the monitor.
Barry McDonagh: I think people will be really glad to hear that because it's such a common thing that when your exhaustion as well, when you're exhausted or highly anxious, you get that extra thud, thud, or the ectopic beats, all of that.
Sanjay Gupta: Absolutely, now here's another really interesting study that I wanted to share with you. There's a place in America where if you have an emergency in the hospital, an alarm goes off and everyone gets woken up.
And so what these researchers did was they looked at those people who were on heart monitors and they studied them on the nights when the alarm went off and the nights when the alarm didn't go off. And on the nights the alarm went off, they got a lot more skipped beats.
So that was interesting but not surprising because it's an anxiety inducing thing when the alarm goes off, but very interestingly, the next day when you look at these people, they had a ton more skipped beats during the day.
So there seems to be this delayed effect. So a lot of people then will say to me, for example, why did I get skipped beats today? I was okay and I said, well, actually, it maybe because you didn't sleep very well the night before or the two nights before. There is this delayed effect, so exhaustion plays a big role.
Barry McDonagh: So we have technology now, we have Fitbits, we have apps tracking blood ... not blood pressure but more heart rate all the time as well, so people can get quite obsessed about what their heart rate is.